Kayla D. Skinner

Smoking, food, and alcohol cues on subsequent behavior: a qualitative systematic review.

Although craving is a frequent phenomenon in addictive behaviors, and laboratory paradigms have robustly established that presentation of cues can elicit self-reported craving responses, extant work has not established whether cue exposure influences subsequent behavior. We systematically review extant literature assessing the effects of cue exposure to smoking, food, and alcohol cues on behavioral outcomes framed by three questions: (1) Is there value in distinguishing between the effects of cue exposure on behavior from the responses to cues (e.g., self-reported craving) predicting behavior?; (2) What are the effect of cues on behavior beyond lapse, such as broadly considering both target-syntonic (e.g., do cigarette cues predict smoking-related behaviors) and target-dystonic behaviors (e.g., do cigarette cues predict other outcomes besides smoking)?; (3) What are the lessons to be learned from examining cue exposure studies across smoking, food and alcohol domains? Evidence generally indicates an effect of cue exposure on both target-syntonic and target-dystonic behavior, and that self-report cue-reactivity predicts immediate target-syntonic outcomes. Effects of smoking, food and alcohol cues on behavior are compared to elucidate generalizations about the effects of cue exposure as well as methodological differences that may serve the study of craving in the future.

Introspective responses to cues and motivation to reduce cigarette smoking influence state and behavioral responses to cue exposure.

In the current study, we aimed to extend smoking cue-reactivity research by evaluating delay discounting as an outcome of cigarette cue exposure. We also separated introspection in response to cues (e.g., self-reporting craving and affect) from cue exposure alone, to determine if introspection changes behavioral responses to cigarette cues. Finally, we included measures of quit motivation and resistance to smoking to assess motivational influences on cue exposure. Smokers were invited to participate in an online cue-reactivity study. Participants were randomly assigned to view smoking images or neutral images, and were randomized to respond to cues with either craving and affect questions (e.g., introspection) or filler questions. Following cue exposure, participants completed a delay discounting task and then reported state affect, craving, and resistance to smoking, as well as an assessment of quit motivation. We found that after controlling for trait impulsivity, participants who introspected on craving and affect showed higher delay discounting, irrespective of cue type, but we found no effect of response condition on subsequent craving (e.g., craving reactivity). We also found that motivation to quit interacted with experimental conditions to predict state craving and state resistance to smoking. Although asking about craving during cue exposure did not increase later craving, it resulted in greater delaying of discounted rewards. Overall, our findings suggest the need to further assess the implications of introspection and motivation on behavioral outcomes of cue exposure.

Quit interest influences smoking cue-reactivity

Interest in quitting smoking is important to model in cue-reactivity studies, because the craving elicited by cue exposure likely requires different self-regulation efforts for smokers who are interested in quitting compared to those without any quit interest. The objective of the current study was to evaluate the role of quit interest in how cigarette cue exposure influences self-control efforts. Smokers interested in quitting (n=37) and smokers with no interest in quitting (n=53) were randomly assigned to a cigarette or neutral cue exposure task. Following the cue exposure, all participants completed two self-control tasks, a measure of risky gambling (the Iowa Gambling Task) and a cold pressor tolerance task. Results indicated that smokers interested in quitting had worse performance on the gambling task when exposed to a cigarette cue compared to neutral cue exposure. We also found that people interested in quitting tolerated the cold pressor task for a shorter amount of time than people not interested in quitting. Finally, we found that for people interested in quitting, exposure to a cigarette cue was associated with increased motivation to take steps toward decreasing use. Overall these results suggest that including quit interest in studies of cue reactivity is valuable, as quit interest influenced smoking cue-reactivity responses.

Non-Alcoholic Beverage Cues as Specific Comparison Images to Alcohol Image Cues

ABSTRACT Background: Visual alcohol cues are often used to elicit craving (e.g., cue-reactivity), and selection of appropriate comparison cues is important to isolate the specific effect of craving for alcohol. Objectives: In the current study, via the development of a new set of non-alcoholic beverage cues, we examine measurement and methodological choices in testing alcohol images for cue-reactivity studies. Methods: The current project combined two independent studies of hazardous (Study 1; n = 80) and recent drinkers (Study 2; n = 244) recruited from Amazon Mechanical Turk. Participants viewed either alcohol cues (Lovett, Ham, & Veilleux, 2015) or newly developed non-alcoholic beverage cues. We also randomly assigned people to rate the cues regarding motivational (e.g., affect, craving for alcohol, resistance to alcohol) responses or non-motivational features (e.g., artistry). Results: In Study 1, we included presentation of non-beverage objects, and found that beverages were rated as more positive, less negative and with higher craving than non-beverage objects. In the combined sample, we found that the alcohol beverage cues were associated with greater craving than non-alcoholic beverage cues, and that there were no differences between cue types on either positive or negative affect. We also found an interaction between drinking experience and cue type in predicting resistance to drinking. Conclusions: We conclude that the choice of control cues in alcohol cue-reactivity studies is important, and that the currently developed non-alcoholic beverage cue set provides an adequate control for alcohol beverage cues for use in cue-reactivity paradigms.

The dynamics of persisting through distress: Development of a Momentary Distress Intolerance Scale using ecological momentary assessment.

Distress tolerance, or the ability to withstand uncomfortable states, is thought to be a transdiagnostic risk factor for psychopathology. Distress tolerance is typically measured using self-report questionnaires or behavioral tasks, both of which construe distress tolerance as a trait and downplay the potential variability in distress tolerance across time and situation. The aim of the current study was to provide a method for assessing momentary distress tolerance using ecological momentary assessment to capture both within- and between-individual information. Participants (n = 86) responded to random prompts on their cell phones seven times per day for one week, which included 10 momentary distress tolerance items as well as momentary emotion. After examining item distributions and interclass correlations, we conducted a multilevel exploratory factor analysis using both within-individual and between-individual data to arrive at a brief, 3-item measure we call the Momentary Distress Intolerance Scale. Model fit and reliability indices were good for both within- and between-individual approaches. We found that distress tolerance varied significantly over time, and that average momentary distress intolerance and instability in momentary distress intolerance were associated with trait distress tolerance, emotion dysregulation and tendencies to use experiential avoidance. Neither average momentary distress intolerance nor instability in momentary distress intolerance correlated with behavioral distress tolerance tasks. We discuss the importance of construing distress tolerance from a dynamic perspective and provide recommendations toward future research.

Examining the effect of cue exposure and introspective responses to cues on impulsivity in restrained and unrestrained eaters

The current study extends cue-reactivity research by evaluating impulsive valuation as an outcome of exposure to food cues. This study also separates introspection after viewing cues (e.g., responding to questions about craving and affect) from mere cue exposure, to examine if introspection changes self-regulation behaviors in response to food cues. Finally, we compared restrained and unrestrained eaters to ascertain the influence of motivation toward food on how cue-reactivity influences impulsive behavior. In the current study, restrained and unrestrained eaters were randomly assigned to view food or neutral cues and were randomized to respond to cues with either craving and affect questions (e.g., introspection) or filler questions. Following cue exposure, participants completed a purchase task as a measure of impulsive lack of self-control. Results revealed that unrestrained eaters who introspected on craving and affect showed decreased impulsive behavior, whereas restrained eaters who introspected on craving and affect showed increased impulsive behavior. Although there was no effect of food cues on impulsive behavior, the interaction of introspective response and restraint status suggests that attending to craving and affect has differential effects on subsequent self-control behavior for restrained and unrestrained eaters. Implications for further cue-reactivity work and treatment of chronic dieters (i.e., restrained eaters) will be discussed.

The Interactive Effects of Drinking Motives, Age, and Self-Criticism in Predicting Hazardous Drinking

ABSTRACT Background: Individuals who disclose hazardous drinking often report strong motives to drink, which may occur to modulate views of the self. Investigating self-criticism tendencies in models of drinking motives may help explain who is more susceptible to drinking for internal or external reasons. As much of the research on drinking motives and alcohol use is conducted in young adult or college student samples, studying these relations in a wider age range is clearly needed. Objectives: The current study examined the interactive relationship between drinking motives (internal: coping, enhancement; external: social, conformity), levels of self-criticism (internalized, comparative), and age to predict hazardous drinking. Methods: Participants (N = 427, Mage = 34.16, 54.8% female) who endorsed drinking within the last year completed an online study assessing these constructs. Results: Results indicated internalized self-criticism and drinking to cope interacted to predict hazardous drinking for middle-aged adults. However, comparative self-criticism and conformity motives interacted to predict greater hazardous drinking for younger-aged adults. In addition, both social and conformity motives predicted less hazardous drinking for middle-aged adults high in comparative self-criticism. Conclusions/Importance: Interventions that target alcohol use could minimize coping motivations to drink while targeting comparative self-criticism in the context of social, and conformity motives.